ECMO: A potentially life-saving option for cardiac patients
The ECMO procedure can restore the functions of the heart and lungs in cases of cardiac and respiratory failure, but is not a one-size-fits-all approach.
What is ECMO?
Extracorporeal membrane oxygenation (ECMO) is a procedure that has the potential to save the lives of patients with life-threatening cardiothoracic illnesses, Dr Su Jang Wen explains.
During the surgical procedure, a pump is used to circulate blood outside the body and through a machine that removes carbon dioxide first and then adds oxygen to the blood before pushing it back into the arteries. This takes over the vital functions performed by the heart and lungs, thus allowing the heart and lungs to rest. Patients on ECMO can survive for weeks even if the heart has stopped beating.
“Time is the best medicine”, says Dr Su Jang Wen. “If you give it time, a damaged heart gets less swollen and it starts to beat again.”
Who is a suitable candidate for ECMO?
In theory, any patient suffering from heart or lung failure due to a variety of conditions, including heart attack and pneumonia, can benefit from ECMO. In practice, a few doctors consider ECMO a viable option to resuscitate patients, says Dr Su.
“Doctors are often unaware of how good ECMO can be.”
He believes this is well demonstrated by the case of a friend in her 30s who was admitted to the hospital with a severe infection on a Friday night, before quickly deteriorating and dying on Sunday. The team of doctors treating her ruled out the possibility of starting ECMO.
“Maybe ECMO wouldn’t have saved her, but the woman wasn’t given the best available chance,” he says.
Despite praising ECMO’s life-saving potential, Dr Su acknowledges it is tricky for doctors to make the right call because the procedure is not suitable for every patient and comes with a hefty cost.
“ECMO is a double-edged sword that can save patients but also bankrupt their families.”
The treatment often costs between SGD$10,000 and $15,000 per day, and lasts for several weeks. Hence, it is crucial for doctors to select only those patients whose condition is potentially reversible, so that they stand a chance of recovery.
For example, patients with a terminal illness like late-stage cancer are not recommended to undergo ECMO because, on average, they would gain no more than 1 extra month of survival. In contrast, ECMO may be recommended for people with a potentially reversible infection because it would provide time for the required medication to work.
A call for widespread adoption of ECMO
Dr Su is positive that many lives could be saved if hospitals adopted ECMO as a standard procedure to resuscitate patients in the wake of a collapse due to respiratory or cardiac arrest. This would keep the patient's organs in a stable condition while doctors come up with the best possible therapy. “Keep the patient alive first and then decide on the next step,” he says.
“The whole medical community has to understand that ECMO is a clinical intervention that could do miracles for patients.”
The article was originally published on the website of Global Health and Travel magazine.
Article with contribution from Dr Su Jang Wen, Cardiothoracic Surgeon at Gleneagles Hospital.
Dr Su Jang Wen is a thoracic and cardiovascular surgeon at Gleneagles Hospital, Singapore. He was the chief fellow of the Thoracic Surgery & Lung Transplantation Programme at the Cleveland Clinic in the United States. He performs a full spectrum of treatments for cardiac and thoracic conditions and a variety of heart surgery including coronary artery bypass graft, mitral valve repair/replacement, aortic valve replacement and aortic dissection repair.
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